|
|
55 Fruit Street
Yawkey Center for Outpatient Care
Suite 3200, 3G, Room 3-046
Boston, MA 02114
Phone: (617) 724-7300
Fax: (617) 724-3846
|
| |
Mondays 1:00-4:00pm
Tuesdays 8:00am-4:00pm
|
| |
|
Please bring all old records, x-rays, CT scans, and MRI’s. Always bring the actual films, if available. Please bring all doctors' notes and prior operative reports. Female patients should bring a tank top or jog bra.
|
| |
|
If you have an emergency during the day you can call our office directly at (617) 724-7300. If you have an emergency after office hours there is an orthopaedic resident on call 24 hours/day and he can be reached at (617) 726-2000 through the page operator at Massachusetts General Hospital. He can decide if you need to come to the hospital or go to your local hospital and he can contact Dr. Warner directly.
|
| |
Blue Cross
Blue Shield
Indemnity Blue Cross
Blue Shield Managed Care
HMO Blue
Blue Care
65 Blue Care
Elect Harvard Pilgrim Health Plan
Medicaid
Medicare Neighborhood Health Plan
Tufts Health Plan
All private insurance, workmen's compensation, and out of network visits
|
| |
|
Do not eat or drink anything after midnight of the night before your surgery. Do not apply deodorant in the morning of your surgery under the arm of the shoulder which will be operated. If you are having out-patient surgery and going home after your surgery, make sure you have someone who can drive you home later in the day.
|
| |
Rehab Protocols
What to expect after arthroscopic shoulder surgery?
It is normal to have swelling and discomfort in the shoulder for several days or a week after surgery. Apply ice bags or use the cryocuff you were given to control swelling. Ice should be applied 20-30 minutes at a time, every hour or two; put a thin towel or T-shirt next to your skin if using ice in a plastic bag. Icing is most important in the first 48 hours, although many people find that continuing it lessens their postoperative pain.
If you had a nerve block, the local anaesthetic may keep your shoulder numb for several hours. You will be given a prescription for powerful pain medication when you are discharged from the hospital. If you find you do not tolerate it well, call our office and we will try another one.
Many patients find that lying down accentuates their discomfort. You might sleep better in a recliner, or propped up in bed. A pillow placed behind your elbow may also help.PUMP YOUR HAND AND MOVE YOUR WRIST AND ELBOW TO KEEP THE BLOOD CIRCULATING AND PREVENT STIFFNESS.
Keep the postoperative dressing clean and dry. Unless it becomes wet or too tight because of swelling, leave the bandages in place for at least two days. TWO DAYS AFTER YOUR SURGERY, REMOVE YOUR BANDAGES. Cover incisions with Band-Aids to keep from snagging the sutures on clothes. You may shower then, but try to keep the incisions dry for the first 10-14 days. Do not wet your incisions directly (bathing or swimming) until at least 2 weeks postop.
The sutures will be removed at your first postoperative visit 7-14 days after surgery. We would like to see you back in the office 7-14 days after surgery. If you don't have your first post-operative visit scheduled, call our office to make one.
If you have an arthroscopic reconstructive procedure such as an instability repair, labral repair, or rotator cuff repair, your arm will be in a sling for four weeks. You can remove the sling to go in the shower; however, keep your arm at the side and do not use it actively. Do not move the arm out to the side. You can type on a computer with your arm at the side and you can bend your elbow to feed yourself. Otherwise keep the sling on. After four weeks, we will prescibe a physical therapy program appropriate for your shoulder. It often helps to call before surgery to make an appointment with your physical therapist.
Be in the care of a responsible adult. Abstain from drinking alcoholic beverages and from smoking. You may eat a regular diet, if not nauseated. Drink plenty of non-alcoholic, non-caffeinated fluids. Do not make important decisions or sign legal documents. Plan to take a few days off work. If you have a simple shoulder arthroscopy like an acromioplasty or A.C. joint resection, you can remove your sling on the mornging after surgery. Follow guidelines above for keeping the incision dry.
Other Procedures:
Arthroscopic Release of a Frozen Shoulder -- Patients often remain in the hospital for two days in order to have pain control by intravenous medicines or by a catheter that numbs the nerves down the arm. You should arrange in advance for your physical therapy to start immediately on discharge from the hospital. This is important so as not to lose any motion gained by the arthroscopic release. You should start to use your arm right away and not wear your sling. Therapy is usually ordered for every day (five days/week) for the first two weeks and then adjusted by us after your first office visit.
Total or Partial Shoulder Replacement for Arthrithis or Fracture -- Therapy may or may not begin immediately on leaving the hospital. You will be instructed if you can do pendulum exercises on your own and you may see a therapist in the hospital for therapy. This depends on the type of surgery you have. You can use your arm from the elbow down but no active motion of the shoulder until ordered by us. We will review this with you on your first visit after surgery.
Rotator Cuff Repairs -- Then tendon repair needs 4-6 weeks to heal so active motion of the shoulder is not permitted during this time. Therapy will usually begin after your first visit to us and will be passive motion performed by the therapist. In some cases we will allow you to go in a pool and do motion under water where your arm will be weightless. You will need to wear your sling for 4-6 weeks. After this period you will begin a program of active motion and, eventually, strengthening.
|
| |
|
If you have your insurance through HMO, you are required to have a referral from your PCP (Primary Care Physician). Please make sure to provide us with a telephone number where you can be reached in the event of an emergency which might affect your scheduled visit.
|
| |
Protocol for Antibiotics After Joint Replacement:
The development of infection following total joint replacement is a serious problem. Although rare, there are documented cases of such infection caused by bacteria introduced into the bloodstream during certain dental procedures. Various approaches can be taken towards preventing this, especially with regard to the use of antibiotics before undergoing a dental procedure. The faculty has recently reviewed the medical literature and advisory statement put forth by the American Academy of Orthopedic Surgeons and the American Dental Association, and they offer the following recommendations.
PROPHYLACTIC ANTIBIOTICS SHOULD BE GIVEN TO:
- All patients who have had a joint replacement within two years, regardless of the type of dental procedure or patient health status.
- All patients, who are immunocompromised, have insulin dependant diabetes mellitus, or systemic inflammatory disease such as rheumatoid arthritis or systemic lupus erythematosis, regardless of how long ago they have had surgery.
- All patients, regardless of health status or how long ago they have had surgery, who are having invasive dental procedures. These include extractions, periodontal procedures, dental implant placement, root canals or teeth cleaning likely to cause bleeding.
Prophylaxis should consist of a single 2-gram dose of amoxicillin or cephalexin given orally one hour prior to the dental procedure. In-patients, who are allergic to penicillin, 600mg of clindamycin may be given instead. If a patient is unable to take oral medications, 1-gram of IM/IV cephalexin or 2-grams of IV/IM ampicillin is recommended. Finally if a patient is allergic to penicillin and unable to take oral medications a single 600mg dose of IM/IV clindamycin should be taken one hour prior to the dental procedure. If you are undergoing a dental procedure, or even some other invasive procedure such as cystoscopy or sigmoidoscopy, you should inform your dentist or doctor that you have had a joint replacement. Please call our office if you have additional questions or need a precription.
|
| |
|
|
